Provider Demographics
NPI:1093109639
Name:SYNERGY MYOFASCIAL RELEASE & REHAB, INC.
Entity Type:Organization
Organization Name:SYNERGY MYOFASCIAL RELEASE & REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:1ST PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:601-259-5657
Mailing Address - Street 1:115 VILLAGE SQ STE K
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6069
Mailing Address - Country:US
Mailing Address - Phone:601-398-3171
Mailing Address - Fax:601-292-7171
Practice Address - Street 1:115 VILLAGE SQ STE K
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-6069
Practice Address - Country:US
Practice Address - Phone:601-398-3171
Practice Address - Fax:601-292-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-21
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA3488261QP2000X
MSPT4447261QP2000X
MSPT2361261QP2000X
MSPT1451261QP2000X
MSPTA5587261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy